Healthcare Provider Details

I. General information

NPI: 1679522403
Provider Name (Legal Business Name): SOUTHWEST CARDIOVASCULAR CONSULTANTS,SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 BLACK RD SUITE A
JOLIET IL
60435-2929
US

IV. Provider business mailing address

2801 BLACK RD SUITE A
JOLIET IL
60435-2929
US

V. Phone/Fax

Practice location:
  • Phone: 815-740-1100
  • Fax: 815-725-2413
Mailing address:
  • Phone: 815-740-1900
  • Fax: 815-725-2413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number042007380
License Number StateIL

VIII. Authorized Official

Name: DR. DENNIS M. KILLIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 815-740-1900